Provider Demographics
NPI:1134998180
Name:GUILL, TAYLOR RENEE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:GUILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 HARNETT ST APT 306
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3184
Mailing Address - Country:US
Mailing Address - Phone:812-820-9019
Mailing Address - Fax:
Practice Address - Street 1:321 N FRONT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3908
Practice Address - Country:US
Practice Address - Phone:252-320-9179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health